Granting patients access to their electronic health records (EHRs) resulted in more office visits, hospital admissions and emergency room encounters compared to those without access, Ted E. Palen, MD, PhD, MSPH, of the Institute for Health Research at Kaiser Permanente Colorado in Denver, and colleagues reported in the Journal of the American Medical Association.

"Our findings suggest that the relationship between online access and utilization is more complex than the simple substitution of online for in-person care suggested by earlier studies," the researchers wrote. "As online applications become more widespread, health care delivery systems will need to develop methodologies that effectively integrate health information technologies with in-person care."

Palen and colleagues compared use of health care services among 44,321 Kaiser members who joined MyHealthManager, an online patient access system, with matched controls who did not join the system from 2006 to 2009.

Increases in the following areas were noted among MyHealthManager participants:

Office visits -- 0.7 per member per year (P<0.001)

Telephone calls to clinicians -- 0.3 per member per year (P<0.001)

After-hours clinic visits -- 18.7 per 1,000 members per year (P<0.001)

Emergency room visits -- 11.2 per 1,000 members per year (P=0.01)

Inpatient admissions -- 19.9 per 1,000 members per year (P<0.001)

Video: Patient access to health records boosts utilization

Members who used MyHealthManager were able to view test results, vaccination records, active prescriptions, lists of diagnoses, problems noted by their clinicians and management plans. It also allowed members to schedule regular appointments, request prescription renewals and communicate with physicians via a secure messaging system.

All Kaiser Permanente Colorado members were invited to participate, but only slightly more than half did so. To be included in the study, members needed to be continuously enrolled for at least two years from 2005 to 2010 and active in MyHealthManager for at least one year after account activation.

Despite overall increases in utilization, record access did not appear to influence utilization in patients with certain chronic illnesses.

No significant changes in any service type were noted for patients with coronary artery disease, nor in most service types for those with heart failure or diabetes.

Patients with asthma had significant or nearly significant changes in office and emergency department visits and in inpatient admissions, but not for phone calls or after-hours clinic visits.

In an accompanying editorial, David W. Bates, MD, MSc, and Susan Wells, MBChB, of Brigham and Women's Hospital in Boston, noted that the study findings contrasted with earlier studies from other Kaiser sites that showed patient access to EHRs reduced service utilization.

Although there is no apparent explanation for the discrepancies, Bates and Wells suggested differences in patient populations may be responsible for the different findings. They called for more studies, both within the Kaiser system and with different service models, to better understand "specific modules and applications" that benefit patient care rather than encouraging overuse.

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